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胸部孤立性纤维瘤CT、FDG-PET/CT表现及病理对照

作者:周 洁1 曾旭文1 梁治平1 陈 淮2 王寿扬2 陈 松1 钟敏之1

所属单位:1.暨南大学医学院附属广州红十字会医院(广州市红十字会医院)放射科(广东 广州 510220) 2.广州医科大学附属第一医院放射科(广东 广州 510120)

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摘要

目的探讨胸部孤立性纤维瘤 (SFT)的CT、FDG-PET/CT表现及其诊断价 值。方法 回顾性分析临床资料完整、经 病理证实的38例胸部SFT的CT与FDG-PET/ CT影像表现,并与其病理组织学及免疫组 织化学检测结果进行对照分析。结果 38 例CT及PET/CT均表现为胸部单发肿块,位 于胸膜者20例,肺内13例,胸壁2例,纵 隔3例。肿瘤最大径为1.60cm-16.60cm, 中位数为5.50cm。CT平扫密度不均匀26 例,其中坏死、囊变13例,出血4例,钙 化6例。CT增强扫描38例呈不同程度强 化。7例行PET/CT检查,其中6例FDG摄取 增高,最大标准摄取值(SUVmax)为4.7。 结论 CT能清晰显示肿瘤大小、密度、边 界及其对周围组织的侵犯,PET-CT实质部 分表现为FDG摄取增高,SUVmax值有助于 胸部SFT良恶性的鉴别。

Objective To investigate the CT and FDG-PET/CT characteristics and the diagnostic value in the thoracic solitary fibrous tumor(SFT). Methods CT and FDGPET/CT features of thoracic SFTs confirmed by pathology in 38 cases with complete clinical data were analyzed retrospectively in comparision with the histopathological and immunohistochemical findings. Results All the 38 cases showed the thoracic single mass on CT and PET/CT images. Among them, 20 located in the pleura, 13 located in the lung, 2 located in the chest wall and 3 in the mediastinum. The maximal diameter of the tumors ranged from 1.6 to16.6 cm and the average tumor size was 5.5 cm. On plain CT scan, 26 SFTs showed inhomogeneous density, among which necrosis and cystic area were observed in 13 cases, hemorrhagic foci were detected in 4 cases and calcification were seen in 6 cases. On enhanced CT scan, 38 cases showed different degrees of enhancement. There were 7 cases scanned by PET/CT, and 6 cases were positive on PET imaging. The maximal SUV value was 4.7. Conclusion CT can clearly show the size, density, edge and invision to the surrounding tissues, with mostly increased FDG uptake on PET/CT. SUVmax is helpful in differentiating benign and malignant thoracic SFTs.

【关键词】孤立性纤维瘤;胸部;体层摄影术,X线计算机;正电子发射计算机断层扫描

【中图分类号】R734.3 R814.42

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.11.016

前言

孤立性纤维瘤(solitary fibrous tumor,SFT)是一种少见的间叶 源性肿瘤,曾被命名为独立性纤维性间皮瘤、胸膜下纤维瘤和局限性 纤维瘤,约占软组织肿瘤的0.6%,具有向成纤维细胞/肌纤维母细胞转 化的倾向[1]。国内外关于胸部SFT影像表现的报导多以个案为主,缺少 大宗病例的研究报道,对于良恶性的鉴别较少提及,术前诊断准确率 较低。因此,笔者搜集本院2009年10月至2015年1月经手术和病理证实 的38例胸部SFT的病例资料,分析其CT、PET/CT表现,旨在提高SFT的 影像诊断水平。